Abstract
Objective: 1) Describe the intraoperative blood loss during adenotonsillectomy in a pediatric population during the transition to a new technique. 2) Confirm or refute the suspicion that intraoperative blood loss is greater when using the microdebrider than when using traditional curette and electrocautery techniques.
Method: Retrospective evaluation of 148 children who underwent tonsillectomy and/or adenoidectomy by a single surgeon transitioning from curette and electrocautery to microdebrider in 2008. Primary outcome was percentage of circulating blood volume lost. Surgical methods were compared by multiple linear regression and chi-squared to evaluate incidence of “bleeders” (>5% loss).
Results: Median age was 6.8 years (range, 2.2-20.6 years). 84 had adenotonsillectomy, 39 had adenoidectomy, and 25 had tonsillectomy. Blood loss ranged from 0% to 15% (median = 2%) blood volume. Sixteen of 148 patients (11%) lost >5% blood volume. A total of 2.3% of blood volume was lost with adenoidectomy by curette or microdebrider compared to no adenoidectomy (P = 6e-07). Microdebrider tonsillectomy was associated with more blood loss than electrocautery; an additional 1.7% of blood volume (P = 9e-06). A total of 15 of 84 (18%) who had adenotonsillectomy lost >5% blood volume. 26% of microdebrider patients lost >5% blood volume compared to 12% of electrocautery tonsillectomy patients (P = .16).
Conclusion: Adenoid and/or tonsil surgery can result in significant blood loss (>5% of blood volume), which occurred in 11% of our cases. Most of the blood loss is from the nasopharynx. Tonsillectomy by electrocautery is associated with significantly lower intraoperative blood loss than the microdebrider.
Get full access to this article
View all access options for this article.